COVID-19 Reporting Form

For confidential reporting of a positive COVID-19 test result, please fill out the following form.

University staff will record positive test results and provide students with important information regarding health, housing and academic resources. 

As necessary, students will be referred to their primary care provider or to UB Health Services for medical care - this process is not intended for treatment, diagnosis or immediate medical support.

Contact Information

(Required)
(Required)
(Required)
(Required)
(Required)
Including area code

Medical Information

Have you had any symptoms?
Have you had any symptoms?
(Required)
 
 
 
(Required)

Housing Location

Housing location during the semester?
Housing location during the semester?
(Required)
 
 
 
 
Where are you isolating?
Where are you isolating?
(Required)
 
 
 
 
 
(Required)

Last Physical Contact with Campus

(Required)
(mm-dd-yyyy)

Request Assistance

Please tell us if you would like additional information about:
Please tell us if you would like additional information about:
 
 
 
 
 

Additional Assistance

Health Services

Student Life

University at Buffalo
Michael Hall, 3435 Main Street, South Campus
Buffalo, NY 14214

Phone: (716) 829-3316; Fax: (716) 829-2564